This document provides information on various vaccines including their composition, administration, and schedules. It discusses key details of vaccines for diseases like tuberculosis (BCG), polio, hepatitis B, diphtheria-pertussis-tetanus (DPT), influenza, rotavirus, pneumococcal pneumonia, measles, rubella, mumps, typhoid, varicella, human papillomavirus (HPV), and meningococcal infections. The goals, mechanisms of action, dosage, routes of administration, and protective effects of different vaccine types like live attenuated, killed, toxoid, subunit, and conjugate vaccines are outlined. National immunization schedules for infants, children, pregnant women, and adults are

1. VACCINES

2. • Immunity a state of relative resistance to an infection.
• Goal of immunization???
• Edward Jenner 1796 small pox vaccine first live,
attenuated viral vaccine documented.
• Robert Koch 1876 demonstrated specific bacterial cause
of anthrax.

3. • Immunity:
• Natural:
• Species immunity
• Individual Immunity
• Acquired:
• Active Immunity
• Passive Immunity

4. ACTIVE IMMUNITY
• Antigenic stimulus production of antibodies initiates cellular
response mediated by lymphocytes and macrophages.
• Acquired in 3 ways:
1. Following clinical infection
• Eg: Chicken pox, Rubella, Measles
2. Following subclinical infections
• Eg: Polio, Diphtheria
3. Following immunization with antigen

5. ACTIVE IMMUNITY
• Important protective antibodies:
• Antitoxins
• Opsonins
• Lysins
• Neutralizing antibodies
• Antiadhesins

6. ACTIVE IMMUNITY
• In case of viral diseases
• Interacts with virus before initial intracellular penetration occurs.
• Prevents local replicating virus from disseminating from site of
entry to target organ.

7. PASSIVE IMMUNITY
• No antigenic stimulus
• Involves transfer of preformed antibodies into recipients
• Natural: Trans placental; breast milk
• Artificial:
• Administration of antibodies preformed in other human (Ig)
• In animals. Eg: Horses.

8. IMMUNE RESPONSE
• PRIMARY RESPONSE
• Antigen administered for first time
• Latent period 3-10 days for antibodies to appear
• IgM titer raises in 2-3 days, reaches peak and declines
• More antigenic stimulus IgG
• Imp outcome Production of memory cells by B & T
lymphocytes immunological memory

9. FACTORS DETERMINING NATURE, EXTENT OF
PRIMARY RESPONSE
• Dose of antigen
• Nature of antigen
• Route of administration
• Adjuvants
• Nutritional status of host.

10. SECONDARY (BOOSTER) RESPONSE
• Differs from primary response:
• Short latent period
• Rapid production of antibody
• Abundant antibody
• Maintained at higher level and for longer time
• Greater capacity to bind to antigen

12. • 5 recognizable types of vaccines:
• Live attenuated
• Killed
• Toxoid
• Bacterial cell component
• Viral subunit

13. LIVE ATTENUATED VACCINES
• Preparation of live bacteria/ virus.
• Reduced virulence.
• Single dose.
• Disadvantage:
• Microbes may replicate loss of attenuation Infection.

14. LIVE VACCINES
BACTERIAL VACCINES VIRAL VACCINES
Bacillus Calmettee Guerin
(BCG)
Poliomyelitis oral live (OPV/ Sabin)
Typhoid Ty 21 a Measles
Mumps
Rubella
Varicella
Yellow fever

15. KILLED VACCINES
• Suspension of bacteria/virus killed by heat/ disinfectants
(phenol/formaldehyde)
• Do not replicate.
• Multiple doses
• Secondary immune response

16. KILLED VACCINES
BACTERIAL VACCINES VIRAL VACCINES
Anthrax Hepatitis A and B
Cholera Poliomyelitis (IPV/Salk)
Typhoid- Paratyphoid Rabies
Plague Japanese B encephalitis

17. TOXOID VACCINES
• Prepared from toxins secreted by certain species of
bacteria
• Toxin treated with formalin toxicity eliminated &
immunogenicity is maintained.
• Formol toxins.
• Eg: Diphtheria, Tetanus

18. BACTERIAL CELL COMPONENT VACCINES
• Consists of only a component of bacterial cell
• More specific and effective
• Reduced adverse reactions
• Eg:
• Acellular pertussis vaccines
• H. Influenza type B
• N. meningitides type A & C
• 23-valent pneumococcal polysaccharide.

19. NATIONAL IMMUNISATION SCHEDULE
(according to IAP)
AGE VACCINES
BIRTH BCG; OPV(0); Hep- B (1)
6 weeks DTwP (1); IPV (1); Hep- B (2); Hib (1); Rotavirus (1);
PCV (1)
10 weeks DTwP (2); IPV (2); Hib (2); Rotavirus (2); PCV (2)
14 weeks DTwP (3); IPV (3); Hib (3); Rotavirus (3); PCV (3)
6 months OPV (1); Hep- B (3)
9 months OPV (2); MMR (1)

20. AGE VACCINES
9-12 months Typhoid Conjugate Vaccine
12 months Hep- A (1)
15 months MMR (2); Varicella (1); PCV booster
16-18 months DTwP/DTaP (B1); IPV (B1); Hib (B1)
18 months- 2 years Hep A (2); typhoid booster
4-6 years DTwP/ DTaP (B2); OPV (3); Varicella (2);
typhoid booster
10-12 years HPV

21. NATIONAL IMMUNISATION SCHEDULE FOR
INFANTS, CHILDREN, PREGNANT WOMEN (INDIA)
• For Pregnant women
VACCINE WHEN TO GIVE DOSE ROUTE SITE
TT-1 Early in Pregnancy 0.5 ml IM Upper arm
TT-2 4 weeks after TT-1 0.5 ml IM Upper arm
TT-
Booster
If received at 2 TT doses in
a pregnancy within last 3
years
0.5 ml IM Upper arm

22. VACCINE WHEN TO
GIVE
DOSE ROUTE SITE
BCG At birth 0.1 ml (0.05 ml
until 1 month age)
ID Left upper arm
Hepatitis- B At birth 0.5 ml IM Anterolateral aspect of thigh
OPV-0 At birth 2 drops Oral
OPV-1, 2, 3 6, 10, 14
weeks
2 drops Oral
DPT 1, 2, 3 6, 10, 14
weeks
0.5 ml IM Anterolateral aspect of thigh
Hepatitis B
1, 2, 3
6, 10, 14
weeks
0.5 ml IM Anterolateral aspect of thigh
Measles 9-12 months 0.5 ml SC Right upper arm
FOR INFANTS & CHILDREN

23. VACCINE WHEN TO GIVE DOSE ROUTE SITE
DPT booster 16-24 months 0.5 ml IM Anterolateral
aspect of thigh
OPV
booster
16-24 months 2 drops Oral
Measles (2nd
dose)
16-24 months 0.5 ml SC Right upper arm
Japanese
Encephalitis
16-24 months 0.5 ml SC Left upper arm
Vitamin A 16 months 2 ml Oral
DPT booster 5-6 years 0.5 ml IM Upper arm
TT 10 yrs & 16 yrs 0.5 ml IM Upper arm

24. INDIVIDUAL VACCINES

25. BACILLUS CALMETTE GUERIN (BCG)
• Albert Calmette; Camille Guerin (1921)
• Derivative of attenuated bovine strain of tubercle bacilli.
• Danish 1331 strain (WHO)
• Jan 1967, BCG laboratory at Guindy, Chennai.
• Aim to induce a benign, artificial primary infection stimulates acquired
resistance to infection with virulent tubercle bacilli reduces morbidity;
mortality.

27. • TYPES-
• Liquid (fresh) vaccine.
• Freeze dried vaccine more stable.
• STABILITY-
• Several weeks- ambient temperature
• Upto 1 year away from light; in cool environment. Refrigerated <10 ͦ C
• Normal Saline diluent for reconstituting.

28. • DOSAGE: 0.1 mg in 0.1 ml; Newborn 0.05 ml
• ADMINISTRATION: Intradermal injection- Tuberculin syringe
• Site: just above insertion of left deltoid muscle.
• AGE: At birth/ At 6 weeks of age
• PROTECTIVE VALUE: 15 to 20 years.

29. PHENOMENA AFTER VACCINATION
• 2-3 weeks Papule
• 5 weeks Papule increases 4-8mm
• Subsides/ breaks into shallow ulcer
• 6-12 weeks Heals Permanent, tiny, round scar.

30. POLIO VACCINE
• Inactivated (Salk) polio vaccine (IPV)
• Oral (Sabin) polio vaccine

31. DIFFERENCE BETWEEN IPV AND OPV
IPV OPV
Killed formolised virus Live attenuated virus
Given IM/SC Given orally
Induces circulating antibody; no local
immunity
Both humoral and intestinal immunity
Prevents paralysis; does not prevent
reinfection by wild polio viruses
Prevents paralysis and intestinal
reinfection
Not useful in epidemics Effective in controlling epidemics
Content is 10,000 times more than OPV;
Costlier
Cheaper
Does not require stringent conditions
during storage and transportation
Requires to be stored and transported at
sub-zero temperature, unless stabilised

32. HEPATITIS B
• Recombinant vaccine 1986
• Monovalent/ fixed combination (DPT, Hib, hepatitis A, inactivated
polio)
• Dose 10-20 µg (adult)
• Site Deltoid/ anterolateral aspect of thigh
• National Immunisation Program at birth, 6, 10, 14 weeks

33. HBV in adults
• Pre-exposure vaccination indications:
• Persons with high-risk sexual behaviours
• Household contacts of HBs-Ag positive persons
• Injecting drug users
• Recipients of solid organ transplantations
• Occupational risk of HBV infection
• Contraindications:
• H/o allergic reactions

34. SEROLOGICAL TESTING IN VACCINE
RECIPIENTS
• Recommended for persons with
• HBsAg prevalence 2% or more
• Sex and needle sharing contacts of HBsAg positive persons
• Homosexuals
• Injecting drug users

35. HEPATITIS B IMMUNOGLOBULIN (HBIG)
• Used for those exposed to HBsAg positive blood
• To be given within 6 hours
• Dose 0.05-0.07ml/kg body weight
• 2 doses 30 days apart

36. • Combination of HBIG and hepatitis B more efficacious than
hepatitis B alone.
• Ideal for prophylaxis and prevention
• HBIG 0.05-0.07 ml/kg within 24 hrs; Hepatitis B 1 ml IM within
7 days
• 2nd dose 1 month; 3rd dose 6 months later.

37. DPT
• National Childhood Immunisation Programme
• DPT, DTwP, DTaP vaccine
• 3 doses 0.5 ml each IM one month interval
• Given at 6 weeks, 10 weeks, 14 weeks
• Booster dose 16-18 months; 4-6 years
• DT vaccine only at 5-6 years

38. INFLUENZA VACCINES- KILLED
• Recommended strains allantoic cavity of chick embryo
harvested purified killed by formalin/ beta-
propiolactone standardized according to hemagglutinin
content.
• Formulated in aqueous/ saline suspension
• Route Single dose SC/ IM

39. • Dose Adults; children > 3 yrs. 0.5 ml
• Children 6-36 months of age 0.25 ml
• Serum antibodies increase in 1 week; peak in 2 weeks
• Immunity 6-12 months

40. ROTA VIRUS VACCINE
• June 5, 2009 included in all National Immunisation Programs
• 2 types:
• ROTATEQ-
• Pentavalent, Live
• 3 doses- 2 months, 4 months, 6
months
• FDA- Feb 2006
• ROTARIX-
• Monovalent, live attenuated
• 2 doses- 2 months, 4 months
• FDA- April 2008

41. PNEMUOCOCCAL PNEUMONIA VACCINE
• PPV23:
• Polysaccharide non-conjugate vaccine capsular antigen of 23
serotypes.
• Recommended for adults and children > 2years
• Indications:
• Pts undergone splenectomy
• Sickle cell disease
• Chronic disease of heart, lung, liver/ kidney
• Diabetes mellitus, alcoholism
• Generalised malignancies

42. • PPV23
• Dose 0.5ml 25µg of purified capsular polysaccharide
• Primary immunization Single IM (deltoid)/ SC
PNEMUOCOCCAL PNEUMONIA VACCINE

43. • PCV:
• 2 conjugate vaccines available- PCV 10 and PCV 13
• WHO recommendations:
• 3 primary doses 6, 10, 14 weeks
• 2 primary+ 1 booster dose 6 weeks; interval of 4-8 weeks.
Booster dose- 9-15 months.
PNEMUOCOCCAL PNEUMONIA VACCINE

44. MEASLES VACCINE
• Live, attenuated vaccine; Freeze dried product
• 0.5 ml contains > 1000 viral infective unit of vaccine strains
• Injected SC/ IM
• Immune response: Both cellular and humoral

45. MEASLES VACCINES
• REACTION:
• Mild measles illness
• Occurs 5-10 days after immunization
• Fever(1-2 days) & Rash (1-3 days)
• Immunity develops 11-12 days after immunisation

46. RUBELLA VACCINES
• 1979 RA 27/3 Human diploid fibroblast.
• Induces higher antibody titre
• Administered single dose 0.5 ml SC

47. MUMPS VACCINES
• Live attenuated vaccine
• Available strains Jeryl-Lynn; RIT 4385; Leningrad-3; Urabe
strain etc
• Administered single dose 0.5 ml; IM

48. TYPHOID VACCINES
• 2 vaccines licensed-
• Defined subunit antigens (Vi polysaccharide)
• Whole-cell live attenuated bacteria (Ty21a)

49. Vi POLYSACCHARIDE VACCINE
• License- 1994, US
• Composed of purified Vi capsular polysaccharide form Ty2 strain.
• Elicits T-cell independent IgG response
• Administered SC/IM
• Single human dose- 25µg
• Stable for 6months at 37˚C; for 2 years at 22 ˚C
• Storage temperature- 2-8 ˚C

50. Vi POLYSACCHARIDE VACCINE
• 1 dose required.
• Confers protection after 7 days
• Revaccination recommended every 3 years to maintain
protection
• Can be co-administered with other vaccines

51. Ty21a VACCINE
• License- Europe (1983); USA (1989)
• Live attenuated Ty2 strain of S. Typhi
• Orally administered
• Available as enteric coated capsules
• Stable at 25˚C for 14 days.

52. SCHEDULE
• Age: >5 years
• 3 dose regimen: 1, 3, 5th day
• Immunity- after 7 days
• To be repeated every 3 years
• May be given with other vaccines

53. VARICELLA VACCINE
• Live attenuated;
• Recommended for children between 12-18 months
• 0.5 ml/ SC
• Children > 13 years 2 doses with 6 wks- 3months interval
• Combination- MMRV

54. HPV vaccines
• Against cervical cancer, genital warts and other cancers
• Gardasil; Cervarix Dec 2014
• 3 doses interval of 4-8 months
• 0.5 ml/IM

55. MENINGOCOCCAL VACCINES
• Polysaccharide vaccines; Polysaccharide- protein conjugate vaccines
• Available against Meningococci of serogroup A, C, W135 and Y
• Polysaccharide vaccines: Available as:
• Bivalent (A, C)
• Trivalent (A, C, W 135)
• Quadrivalent (A, C, W135, Y)
• Single dose; > 2 yrs of age; SC

56. •CONJUGATE VACCINES:
• Monovalent (A or C) or Quadrivalent (A, C, Y, W135)
• Given IM deltoid/ anterolateral aspect of upper thigh
• Children 2-11 months 2 dose at 2 months interval; booster
dose after 1 year

57. TETANUS TOXOID
• Combined vaccine- DPT
• Monovalent vaccines:
• Plain or fluid (formal) toxoid
• Tetanus vaccine, adsorbed (PTAP, APT)

58. MONOVALENT VACCINES
• 2 doses 0.5 ml each 1-2 months interval
• First booster dose 1 year
• Reactions after injection unlikely

59. PASSIVE IMMUNISATION - TETANUS
• 2 Types:
• Human Tetanus Hyperimmunoglobulin
• ATS
• Human Tetanus Hyperimmunoglobulin
• Dose: 250 IU
• Passive protection upto 30 days
• Serum Institute of India, Pune

60. ATS- Anti-tetanus Serum
• Equine antitoxin
• Dose- 1500 IU; injected subcutaneously
• Passive protection for 7-10 days
• Excreted rapidly;
• Disadvantages:
• Sensitivity reactions

62. RABIES VACCINES
• 2 forms:
• Purified Cell-culture vaccine
• Embryonated egg-based vaccine
• Potency- >2.5 IU per single IM dose (0.5 ml/ 1ml, depending
on type of vaccine)

63. CATEGORIES OF CONTACT WITH
SUSPECTED RABID ANIMAL
POST-EXPOSURE PROPHYLAXIS
MEASURE
Touching/ Feeding animals licks on
intact skin
None
Nibbling of uncovered skin, minor
scratches/ abrasions without bleeding
Immediate vaccination; Local Rx of
wound
Single/ multiple transdermal bites/
scratches, Licks on broken skin;
Contamination of mucous
membranes with saliva from licks;
Contacts with bats
Immediate vaccination;
Administration of rabies
immunoglobulins; Local Rx of
wound.

65. ADVERSE EVENTS FOLLOWING
IMMUNISATION (AEFI’s)
• Vaccine reaction
• Programme error
• Coincidental
• Injection reaction
• Unknown

66. VACCINE REACTIONS
• Common, minor reactions
• Local
• Systemic
• Rare, serious reactions

67. VACCINE RARE, SERIOUS REACTION ONSET
BCG Suppurative Lymphadenitis 2-6 months
BCG Osteitis 1-12 months
Disseminated BCG infection 1-12 months
Hep B Anaphylaxis 0-1 hour
Measles/MMR/MR Febrile Seizures 6-12 d
Thrombocytopenia 15-35 d
Anaphylaxis 0-1 hr
Encephalopathy 6-12 d
Oral Poliovirus Vaccine associated paralytic poliomyelitis 4-30 d
DTP Seizures 0-2 d
Hypotonic Hyporesponsive Episode 0-24 hr
Encephalopathy 0-2 days

68. PROGRAMME ERROR
• Vaccine reconstituted with incorrect diluent
• Improper route of administration
• Large doses administered at once
• Contaminated vaccines
• Contraindications ignored
• Unsterilized syringes and needles

69. CONTRAINDICATIONS
VACCINE CONTRAINDICATIONS
ALL Anaphylactic reaction following previous dose of particular
vaccine
Current serious illness
Live vaccines- MMR, BCG,
Yellow fever
Pregnancy
Radiation Therapy
Yellow fever & Influenza Egg Allergy
Immunodeficiency (from medicine, disease/ symptomatic HIV
infection)
BCG Symptomatic HIV infection
Pertusis Containing Previous anaphylactic reaction
Uncontrolled epilepsy, Progressive encephalopathy

70. THE COLD CHAIN
• A system of storage & transport of vaccines at low temperature
from manufacturer to actual vaccination site.
• Failure Vaccine becomes denatured and ineffective
• Vaccine Protected from sunlight and contact with antiseptics

71. • Polio most sensitive to heat stored at – 20 ˚C
• Freezer Polio & measles
• Not allowed to freeze typhoid, DPT, TT, DT, BCG & diluents.
• Opened multidose vials which have not been fully used should
be discarded.

72. COLD CHAIN EQUIPMENTS
• Walk in cold rooms
• Deep freezers
• Small deep freezers & Ice Lined Refrigerators
• Cold boxes
• Vaccine carriers.

76. REFERENCES
• Park’s text book of Preventive and Social medicine- 23rd edition.
• Medical Immunology- Parslow; Stites- 10th edition
• Kuby Immunology
• Pharmaceutical Microbiology- Hugo & Russel- 6th edition
• www.cdc.gov/vaccines
• www.who.int/immunisation
• Indian Academy of Pediatrics (IAP) Recommended Immunization
Schedule for Children Aged 0 through 18 Years – India, 2014 and
Updates on Immunization.

77. THANK YOU